About

The Institute of Neurological Recovery (INR®) provides medical services to selected patients with selected neuroinflammatory conditions, including chronic neurological dysfunction after stroke and brain injury. The INR’s scientific publications are listed here. Please see the Terms of Use for this website.

Appointments at the INR

Consultation and treatment are by appointment only.  Phone or in-office consultations may be scheduled by calling the INR at +1 (561) 353-9707, Monday-Friday from 9 AM to 6 PM Eastern Time.

Referrals to the INR

The INR welcomes referrals from neurologists, geriatricians, internists, family physicians, other health care providers, or family members of patients with selected neuroinflammatory disorders. Please note: INR medical providers utilize etanercept for a limited number of off-label indications. INR medical staff do not use etanercept for treating Parkinson’s disease, brain tumor, or carpal tunnel syndrome. Individual treatment recommendations are only made following medical evaluation, including history, physical examination, and review of imaging studies.

The INR welcomes telephone inquiries from physicians and family members. In particular, the INR encourages telephone inquiry and discussion with an INR medical provider for those patients referred from locations at a geographic distance from Boca Raton, Florida, prior to appointment scheduling. This is recommended especially for those patients who will be flying across country or from overseas for treatment at the INR, due to the special nature of the services provided at the INR, and the unique experience which the INR has performing anti-TNF treatment for neurological disorders.

INR Scientific Background

In 2010 Edward Tobinick M.D., Medical Director of the Institute of Neurological Recovery, made a stunning discovery: that the neurological status of patients following stroke or brain injury, even years after the acute event, may rapidly improve following the use of perispinal etanercept. Read the Springer press release:

 

New hope for survivors of stroke and traumatic brain injury

Single dose of etanercept targets brain inflammation years after damage

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A new ground-breaking study about to be published in the Adis journal CNS Drugs provides clinical evidence that, for the first time, chronic neurological dysfunction from stroke or traumatic brain injury can rapidly improve following a single dose of a drug that targets brain inflammation, even years after the stroke or traumatic event.

The observational study¹ of 629 patients, conducted over the course of nearly two years, documents a diverse range of positive effects, including statistically significant rapid clinical improvement in motor impairment, spasticity, cognition, etc. in the stroke group, with a similar pattern of improvement seen in the traumatic brain injury (TBI) group. The study involved 617 patients treated an average of 42 months after stroke and 12 patients treated an average of 115 months after TBI, long after further spontaneous meaningful recovery would be expected.

The study was conducted at the Institute of Neurological Recovery (INR) in the USA.

The drug utilized was etanercept, a therapeutic that selectively binds and neutralizes an inflammatory immune molecule that may remain elevated for years following stroke. The anti-TNF fusion protein was administered utilizing a novel delivery method, invented by Edward Tobinick M.D., lead author of the study.

“These results represent a sea change in the therapeutic possibilities for stroke and TBI patients,” said Steven Ralph PhD, Associate Professor at Griffith University School of Medical Science in Australia. “Rarely do we see such a radical breakthrough in medical treatment as this for stroke. A previous example was the advance with thrombolytic therapy using drugs such as tissue plasminogen activator (t-PA) for the treatment of acute stroke with their significant impact when applied at the early stages. However, no similar treatment has existed for chronic stroke until now.”

Professor Ralph recently led a team of physicians to the INR for training in the new [drug] delivery method, prior to their initiation of randomized trials in Australia. “Our team observed, first hand, rapid clinical improvement in stroke patients following this brief office treatment,” said Professor Ralph.

In an accompanying editorial², Professor Ian Clark, a world expert on tumor necrosis factor (TNF) and brain dysfunction, discusses the science underlying the novel treatment method and clinical results. The high prevalence of chronic post-stroke and post-TBI neurological disability, with millions of individuals affected worldwide, highlights the study’s significance.

References:

1. Selective TNF Inhibition for Chronic Stroke and Traumatic Brain Injury – An Observational Study Involving 629 Consecutive Patients…. CNS Drugs. 2012;16(12). DOI 10.1007/s40263-012-0013-2

2. Clark, I. New Hope for Survivors of Stroke and Traumatic Brain Injury. CNS Drugs. 2012;16(12). DOI 10.1007/s40263-012-0014-1 (Free Download).

The INR’s scientific findings have been published in multiple, peer-reviewed medical articles, including articles published in the journals Expert Review of Neurotherapeutics, CNS Drugs, BMC Neurology, Current Alzheimer ResearchClinical TherapeuticsDrug Discovery Today, and Current Medical Research and Opinion. There have been citations to INR publications by hundreds of academic scientists from around the world, including in Nature Clinical Practice Neurology and F1000 Biology.

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